Tylenol Liver Damage (cont.)

Dennis Lee, MD

Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

How can overdose be avoided in children?

The dosing of acetaminophen for children, as previously mentioned, depends on
their weight and age. To avoid overdose in children, follow the same procedures for them as suggested above for adults. Beyond that, two adults should independently determine the dose of acetaminophen for a child. If there is disagreement about the recommended dose, consult a pharmacist or physician. These precautions are not excessive when you consider that in one experimental mock situation, only 30% of adults correctly calculated the dose of acetaminophen for their child. If a baby-sitter is caring for a sick child, parents should carefully write out the dose and schedule for the administration of the drug.
Each year, in children with high fevers who were given repetitive doses of acetaminophen, deaths have occurred due to accidental overdose and the resulting liver damage.

What are the symptoms and signs of acetaminophen-induced liver damage?

Three clinical stages (phases) of acetaminophen-induced liver injury have been described.

During the first phase, that is, the initial 12 to 24 hours or so after ingestion, the patient experiences nausea and vomiting.

For the next perhaps 12 to 24 hours, which is the second phase or the so-called inactive (latent) phase, the patient feels well.

In the third phase, which begins about 48 to as late as 72 hours after the ingestion of acetaminophen, liver blood test abnormalities begin to appear. Most notably, extremely high (abnormal) levels of the liver blood tests, AST and ALT, are common with this type of liver injury. The outcome (prognosis) of the liver injury can be predicted fairly accurately on the basis of the patient's clinical exam and blood tests. For example, at one extreme, if the patient develops severe acid buildup in the blood, kidney failure, bleeding disorders, or coma, then death is almost certain. Only a liver transplant can possibly save such a patient.